670047_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

ivision of Water Resources
Facilit3�Number M U / J - t{ 7 1 and Water Conservation
Q Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit:ER( 7
Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: % i6,
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent
Capacity Pop.
Design Current Design
Wet Poultry C►apacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer Dairy Calf
Dairy Heifer
=Mign Gnrrent Dry Cow
Dr. P,ouIt , Ca aci_ P,o Non -Dairy
Feeder to Finish
( 4
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[:]No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ N ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes�C[:]X
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is "storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6 [�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes ,[] No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t O% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes [—]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ff No
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes rNo
❑ NA ❑ NE
[] NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes y ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: fo 7 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O-No ❑ NA ❑ NE
t
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [lTNA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Yes E,_J �o❑ NA ❑ NE
❑ Yes [ ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 2No 0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ -N ❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or,any additional recommendations or:an y hercomment
!`ain-s�tuatsons_ Use drawings of facilityto Better, egp '
.r
(use addrttonal`,pages-asnecessary):__
4
�� 9 1-
I I
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
yr /!'o`-e�
, �, 7"rp /�S
I
Phone: 'P6%3�y
Date:
21412015

Type of Visit: Q 7Routine
pliance Inspection U Operation Review O Structure Evaluation C) Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up Q Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: j� County: 0AISL J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: t_JdAbgrYftr� MrUCk
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 1 67fl
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design Current
Capacity Pop.
Design C►urrent
C►attle Capacity Pop.
Dai Cow
lf
Wean to Feeder
11
jNon-Layer
I
X
Feeder to Finish
Farrow to Wean
6b
Design Current
Ca acit P,a
Dai Heifer
Dry Cow
Farrow to Feeder
Dty Poultry
Non -Dal
Beef Stocker
Beef Feeder
Farrow to Finish
Layers
Non -Layers
Gilts
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z/No
❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes V'34o
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
M. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [/ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
91X0
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
d)qo ❑ NA ❑NE
24. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E6 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
2�o ❑ NA ❑ NE
❑ NA ❑ NE
11J110 ❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):.;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 10A 00,
Date: I rw
2/4 01 S

121
Type of Visit: Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: (Routine O Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
r
Date of Visit: < Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1 ` 4LeN
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
op.
Wet Poultry
Layer
Design
Capacity
C►urrent
Pop.
Design Current
Cattle C►apacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
!{
Feeder to Finish
j (JJ
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D , P,oul
Design
Ca aci
Current
P,a
Dry Cow
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non-LaMyers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: ) - 1. Date of Inspection: VIOL
Waste Collection & Treatment
r
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
LA cro-J J
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s� 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
.
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en onmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No o . ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
U. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
F2��
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Info
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:j Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspecti;/No.,
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes P " �o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes VNo
N ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 12<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [/] No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [�'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E�J,4 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.:.
Use drawings of facility to better explain situations (use additional pages as necessary).
1. (400�L__ 4J &CL-A3 f
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
0A _ v l Tu f , _i Tk_cl
Lr.L� Phon
✓1�wY�f Date:
;c-3ff
U //.S
15

Type of Visit: Q C�orpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: V Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t~ Arrival Time: 1 4, S Departure Time: ' rj County:0.�i. I� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Joo tl r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: j p
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
Da i Calf
Feeder to Finish
fort
Dairy Heifer
Farrow to Wean
=WeNkign C►urreat Dry Cow
Dr. P,ouI Ca aci P,o , Non -Dairy
ILayers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes L_I No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

F6cili Number: - Date of Inspection:
Waste Collection & Treatment
4.61[s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VN16.
❑ NA
❑ NE
acres determination?
17. Does facility lack for land
Yes
NA
NE
the adequate acreage application?
❑
❑
❑
18. is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box,
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Zo
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fatili Number: - Date of Inspection: j
24 ,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �:o
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yesy ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑,io
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ga o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a<o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
To
❑ NA
❑ NE
Comments (refer to ,... ansitu
Use draw n(r of facility to better explain an YES answers and/or any additional recommendations, or.any other co
9 P y ..
ations (use additional pap -es as -necessary). `
( - 3
Reviewer/Inspector Name: V Phone. V0
1 I)00
Reviewer/Inspector Signature:�166.6taDate:
Page 3 of 3 1 2/ /2014

I
Type of Visit: 0,,7Routine
pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j S(f g / j 3 Arrival Time: I i'Z4j— I Departure Time: G County: oAOS66 .,f Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: `]o ►,1 AJJ4A fM:�LL p_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: It%a 7
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
EEd
DairyCalf
Feeder to Finish
' bpp
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
De P,oul Ca aci P,o ,
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113cef Feeder
Boars
Pullets
113cef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of inspection:
3
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
[] Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 613
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
1Vo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�; o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
L No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes hCJ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes YNo
Yes
❑ Yes 0 1Y
ElYes No
❑ Other:
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes l ]4o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Wo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facitity Number: jDate of inspection:
24. Lid the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
VNo
N ❑ NA ❑ NE
0 NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EXN0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej`No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA 0 NE
[:]Yes io ❑ NA ❑ NE
❑ Yes Ea o ❑ NA ❑ NE
❑ Yes
ETNo NA
❑ NE
[:]Yes
Is 1Vo ❑ NA
❑ NE
❑ Yes
fo ❑ NA .
❑ NE
❑ Yes
' No ❑ NA
❑ NE
Comments (refer to question #):Explain any YES answers and/or any additional recommendations or any other, comments.
Use drawings of facility to better explain situations (use additional nap -es as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6H �j
Phone: ( rw_3
Date:
21412011

Type of Visit: VC lance inspection U Operation Review p Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — • Arrival Time: Departure Time: County: 19AISLQhf Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ,0 NRdIgA MA.t./�. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 00-7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poulh:y Capacity Pop.
La er
Design C*urrent
C*attle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
D . P,oult . C•_a aci. P,o
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
MMMM
Turke s
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
DNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: n - Zt27 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
-1
Identifier:i (>J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
PInto
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑Xb
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E5Nco
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of inspection:
24. Did the'facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Isthe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
VNo
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIvIP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 <No❑ NA
❑ NE
❑ Yes;No
❑ NA
❑ NE
J
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
N❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer. to question # ): Explain any YES answers and/or any additional recommendations. or any other comments" `
Use drawings of facility to better explain situations (use additional pages as necessary).-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C* fL ZM
Date:
21412011

Type of Visit: Q Co pliance Inspection U Operation Review O Structure Evaluation p Technical Assistance U
Reason for Visit: q Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 112n County: aA6UV� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: ``w(L-Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design C►urrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish SOU
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr P,ouIt .
Layers
Design
Ca a_ci
Current
P,o .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
D_ ischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes To
❑ Yes ❑ No
❑NA ❑NE
❑NA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
lo NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
j� Yes
PNon NA
n NE
of the State other than from a discharge?
Page I of 3
21412011 Condnued

Facili Number: - Date of Ins ection: 111
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes (2/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
;Zo/No
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yesal/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
O/No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Ef
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes rX0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 2�;o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check
❑ Yes [No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: -qj Date of Inspection: 2Z.i l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Mo ❑ NA ❑ NE
25! 'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑/ /No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 26No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C14o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
7No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑Yes❑
NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0NNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VN
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Phone: N21;
Date:I
21412011

�`DIVIS[OO of Water Qtiality ;
Facility Number, C Division 0Soil and Water ConservatEon
Agenev "' , � y
Type of Visit com fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= c = i = Longitude: a o = C = S,
�Destgn Current :Design; Current,-�' �` ' - Design Currents
m�
.
" 'alahon
Swine; - Capacity Population Wet Poul Ca aciPo Cattle °> Ca acityPo
try, p ty p. p
ulation.
.`
.. ,�
❑ Wean to Finish
❑ La er
El Dairy
Cow
❑ Beef Brood Cow
❑ Dairy Dairy Calf
❑ Heifer
El D Cow
El Non -Dairy
El Beef Stocker
❑ Beef Feeder
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Zo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ElNA ElNE
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
I2/2$/04 Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Zo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ElNA ElNE
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
I2/2$/04 Continued

Facility Number: 7 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure/1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I VA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Uo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes jWo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
0 ❑NA [-I NE
6 o ❑ NA ❑ NE
❑NA El NE
YN o ❑ NA ❑ NE
Comments (refer to question #): Explain any. YES answers and/or anyrecommenda[ions or afny other comments
Use drawings of facility to better explain situations..(use additional,pages:as necessary);
��,��✓ 5 �� -rE� tAAs6- SY 56 f ►, Z-
_
�
�
Reviewer/ ns ector Name �r-
p ...:.' �70
�7
Phone It 1 % —
Reviewerllnspector Signature:
Date: 8
Page 2 of 3 12128104 `Continued

Facility Number: �- / — !n I Date of Inspection
Re"Ared Records & Documents.
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If es check the appropriate box below.
P g P Y�
❑ Yes
EI No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
FNo
[3NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
El
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El yes
�
E, o ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
a ❑ NA
❑ NE
Additional Comments and/or Drawings: w.
Page 3 of 3 12128104

ti
N
Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Y i) Arrival Time: r� �Q Departure Time: County: ��"� Region:
Farm Name: Owner.Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: U61J�4T}q�% fNj�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: c Longitude: 0 ° 0
Design Current
Design Current Design Current
Swine
Capacity Population Wet Poultry
❑ La er
C•apaeity Population C►attle Capacity Population
❑ Wean to Finish
❑ Dai Cow
❑ Wean to Feeder
IEJ Non -Layer I
❑ DaiKy Calf
Feeder to Finish 7 d
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Beef Feeder
❑ Pullets
El Boars
❑ Beef Brood Co
❑ Turke s
Other ❑Turke Poults
❑ Other Other
Number of Structures: l
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
El Yes WN
❑NA
El NE
El Yes L'J No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
* Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
dNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental notify DWQ
threat,
7. Do any of the structures need maintenance or improvement? El Yes
L1 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
D No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
12No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
ETNo
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[]�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
„,Comments (refer to�questron #) Explatn�any YES�.answers and/or,any,�recomtnendations�or'�,�any�otlier comments.-'Y
�,.
�UseEdrawmgs of factltty,ro better explain situatFons: (use addthonal pages as�ne�cessary) ��.,�� � :
Is".) tjo- 7 J m4w. IJEE 0
&AW-OU (-IJvr 60A1)
Reviewer/Inspector Name I LAL& i '9-c i Phone: 3U
Reviewer/Inspector Signature: Date: t
IQ I
Pape 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ uffip ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes [!(No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
El NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El,�I Yes
`ONo
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E;'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[>No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes L(No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes L2 1vo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,,--,,,,��""
IT No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional C©mmerts�aadl©rDrawings x_=
J
Ld
12128104

Type of Visit 7Routine
pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
ReasonforVisit O Complaint O Follow up O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: 6 Arrival Time: a Departure Time: County: dIMAJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ) %�},.u-Title:
Onsite Representative: >NXj7-A � A L4%L- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: E:] 0 ET
E Longitude: [� o m t
Design Current Design Current
Design C*urrent
Swine Capacity Population Wet Poultry C►apacity Population
Cattle
Capacity Population
❑ an to Finish ❑ Layer
❑ Dairy Cow
❑ an to Feeder 10 Non -Layer I I
Dairy Calf
Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean Dry Poultry
❑ Farrow to Feeder
El Farrow to Finish ❑ Non-Layers
❑ Gilts Eltsers
❑ Boars ❑Pulle
❑ Turke s
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 0 G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structurg I Structure 2 Structure 3 Structure 4
Identifier: WAJ
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L.d No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
at, notify DWQ
environmenta7NO
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ❑ NE
/No
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
U o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
I3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? Yes
© No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes
] No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]E Yes
No
❑ NA
❑ NE
"l
17. Does the facility lack adequate acreage for land application? ❑ Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
WNo
❑ NA
❑ NE
GibEIJ C-N-r"&
S. cA) i✓rIP
Reviewer/Inspector Name ( Phone: 110 770- T
Reviewer/Inspector Signature: Date: 16
Page 2 of :3 I21281#4 Continued

Facility Number: Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to haK41up
components of the CAWMP readily available? If yes, check Lk'Yes El ❑ NA ❑ NE
the appropirate box. ❑ Checklists ❑ Design P ❑ Maps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U(No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E(T) ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �rxo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? UdYes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [,No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E3'*No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Zl No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E N
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
LJ No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number M
0 Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency ✓
Type of Visit pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 7Routine Q Complaint 0 Follow up 0 Referral Q Emergency 0 Other [I Denied Access
Date of Visit: Y Arrival Time: ® Departure Time: County: _QWLIO) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: �j] ' Title:
Onsite.Representative: _ _ Tw-Avv_') _ L t-iLc� X_ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: = 0 0 , = 1{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
T ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design . Current. I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes U4 ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ o
❑ Yes LJ N
❑ NA
❑ NE
❑ Yes ;N/o
❑ NA
❑ NE
12128104 Continued

acility-Number:
Date of Inspection 8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes U/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltb
Eleat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ao ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes UfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Qf No ❑ NA ❑ NE
maintenance/improvement? , ,(
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes CJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
3NNo El NA
E o ❑ NA
❑ NA
L No ❑ NA
L�"No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
.24) S fiaaw & vr°D#j4t6 `
Reviewer/inspector Name LL(Lal Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. C7 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �N0N ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Dl& ❑ N [I NE
❑ Yes CNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L�J N
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
W No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E2 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewertinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
OINo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
jW/No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

vision of Water Quality
riumbe-V7O Division of Soil and Water Conservation
0 Other Agency
Type of Visit xrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �Koutine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time: Departure Time: County:
Region:
Farm Name:
C/Q�—fe/22/x'_� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
yin Phone No•
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: . Latitude: [=] o = ' ❑ Longitude: = o = ' ❑ "
Design Current
urrentDesign
WP
C*urrent
Capacity Population
Wet Poultry Cpulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Da' Cow
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Soars
❑ Pullets
El Beef Brood Cowl
❑ Turke s
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
❑ Wean to Feeder
Non -Layer
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
I2/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
St tune 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) / - h
13. Soil type(s) j ,
v
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any -recommendations or any other comments... .
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I _ f Phone:
144
Reviewer/Inspector Signature: Date: p
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ W UP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Ocrop Yield ❑ 120 Minute Inspections )2"Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ODid the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
cc7jj!�Ieloie a ':�96V6
e Z
ou
V1_2 G 3117
Page 3 of 3 12128104

Type of Visit 0 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time- / 7- D Departure Time: 3 3 t County: Region:
/ r
Farm Name: Sx�N& � GrA&f PT-VOW�i 48 Owner Email: 0d5 va
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f' Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator• %1':IlR�� T
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = g = Longitude: = ° = t ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I I '
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
L D
76D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ barrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
I
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: 01
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes eNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El Yes
�Ao
12 No
❑ NA
❑ NE
❑ Yes ENo ❑ NA ❑ NE
12128104 Continued

Facitity Number: — Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑, No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure'6
Identifier: LACrdDA/1
Spillway?:
Designed Freeboard (in): }
Observed Freeboard (in): �3 %
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E,No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes allo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �,lNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [-IPAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Croptype(s) d Mmva �{�� 5&a G5k/
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
[]Yes ffVo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NN
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![] Yes 14 o
17. Does the facility lack adequate acreage for land application? El Yes [2o
18. Is there a lack of properly operating waste application equipment? ❑ Yes XNo
❑NA El NE
[I NA El NE
❑NA ❑NE
❑ NA ❑ NE
a tz rlaw-
Comm nts(refeto question #) Explain}anyYES answeisand/orany recommendations or any o#her comments.
Use dra s1 ofafaceLty. to better�explain�sEtuattous. {use addihybnaI pages as necessary,):
sFfr."'P ac�=e°.r-a.$h ,ix'rl �a�cw}� "n.. f!<'Y 4-a. "S �•����`r#.F-Fr:�:
f�) Af&60 Ntr cop& of Ge QTXPc6 i-(- of 601(69A K AfJP &99 my kzcrN
►v, tr v -rp J P-PdS�ejt /Z6(,6Rj93 ?� NCc✓
Reviewer/Inspector Name ,L = Phone: �l�Q��•' 31ay o• �3
Reviewer/Inspector Signature: Date: 1,0.r
1 12128104 Continued

Facility Number: — !a Date of Inspection i A
Required Records & Documents
t9. Did the facility fail to have Certificate of Coverage & Permit readily available? UYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ g Other
p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EdNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Li No
❑ NA
❑ NE
WNo
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
A
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
El No
�vrN
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
ElNo
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�(NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E NNo
ElNA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElE Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
N
El NA
[I NE
If yes, contact a regional Air Quality representative immediately
�No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Addtiional Comments and/or Drawings:
12128104

Date of Visit: L Z� 6 Time: 1Z h
Facility Number
Not Operational 0 Below Threshold
19 Permitted ELCCertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _, e!Mry iXdh _ T County: Jef. It,
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative: Lwa+o�/l-t-/
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No:
Integrator.• G
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° 0" Longitude 0' 4 �u
! Design Current Design Current Design Current
Swine Gaaci P,o ulation PoWtry Ca aciN P,a ulation Gattl_e Ga aci P.o ulation
❑ Wean to Feeder
❑ La er ❑ Dairy
❑Non -La er Non -Dairy
Other
Total Design Capacity
Total SSLW
91 Feeder to Finish
❑ Farrow to Wean
arrow
❑Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid TrapsF
❑ Subsurface Drains Present
110 Lagoon Area
JE1 Spray Field Area
❑ No Li uid Waste Mana ement S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste C ll� ectlon & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: (X-7 —
Date of Inspection 1 BW b
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7" Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9" Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markines?
Waste Aorilication
10. Are there any buffers that need maintenance improvement?
11. is there evidence of over application? ❑ Excessive Ponding /+,❑1 ,PeA,N ❑ Hydraulic Overload
12. Crop type /d lflt[H6t � L_ CA) p
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAIANP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DR=Q of emergency situations as required by General Permit?
(W discharge. freeboard problems. over application)
23_ Did ReviewerAnspector rail to discuss reviewrinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
VYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-;:�-•::....;� ,��_� -e—�-� „ems�..�.,�,. :--- :�
bomments,(refer to gnesbon . £itpiaut:auy YES•atts�re zndlor.anyrecoiiiii attons or atry tftlter,coattnents. -
u
.. e,
f;se drawin& of facfflty to better explain s«o-I se addtonaAag Field Copy _ ❑� FinalNotes
�4.L�-Y..":.w,.:n.'-'..�w-i�`_.�49#sg.�:�.�^�."5....�'..�- �€.+k7�'r�'"iY �.%S:r:.sacfl'.E-.xT'+-..x;w�-�._� r---,-,..a"aa-: �.., _eel, e•;
0-7 wt!eA d- i-r''e,co 04 f Ook wAll. a �c.' 4d
.,
d Z , IOVA a �-ZO �• _ Cower 14 foeh /w,el Ai i ZOO 3 •'s 37 �: �7'S6 j� /o✓ m10
®n lLev /.oa h
/fedlt"
7
ewer/Inspector Nameewer/inspector
F
Signature: Date:
05/031VI I Continued

Facility- Number. ' -I - R77 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. «Vere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submersed fill pipe or a permanentitemporary cover?
Additional
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes [I No
05103101

Type of Visit $Xompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 'I& Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Not Operational 0 Below Threshold
® Permitted ,M Certiiied /0 Conditionally Certified /[3 Registered Date Last Operated or Above Threshold:
Farm Name: (��/ N/C4t Z it�i�a? �^Y /JiXSidH County: 4QZ:_Da
Owner Name:
Mailing Address:
Facility Contact: j� �/ Title:
Onsite Representative: //L+�AP�,ISFY7/ ey
Phone No:
Phone No:
Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 u Longitude 0 °
Design. r
Current _ ,Design .Cur.rent, Design _ Current
iiiiiiiiiiii
Swine C•a achy
P.o ulv tion P altry Ca acity Population Cattle Ga aci P,o ulation
❑ Wean to Feeder I
I❑ Layer ❑ Dairy
Feeder to Finish
❑ Non -Layer I I Non-Dairy-1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
0 Boars
Total SSLW
Number of Lagoons ©
❑ Subsurface Drains Present ❑ f.a oon Area
❑ Spray Field Area
Holding Ponds /Solid Traps
❑ No Liquid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes k No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c- If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes j9"
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes f,No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes b9LNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Freeboard (inches):
05103101 Continued

I
Facility Number: G Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes R) No
❑ Yes ® No
❑ Yes ® No
❑ Yes fa No
❑ Yes M No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ER No
11. Is there evidence of over application? ❑ Excessive Ponding ElPAN ❑ Hydraulic Overload ElYes R1 No
12. Crop type A6'-,Wu �16 *,7e-ii 45
/
Oor
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes tNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
e® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
19.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
®No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
X3 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
29 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
fia No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
91 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
E,No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
15INo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments' refer'to uestiou Ex lain an YES a s�rers.,andlor an recommen'dahons'ar an `other comments
(. q p Y Y Y -
Use drawing's of facility to be tter, eiplam situations (use addrhonal gages as aecessar
: }) ❑Field Copy ❑Final Notes
/&50e melee l,�.r� /,A Zj dl
Reviewer/Inspector Name 777¢am f
Reviewer/Inspector Signature: i Date: QZ
05103101 Y Continued

Facility Number: - jD Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
C.No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
RNo
28.
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[[No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
EgLNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
OPNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Zko
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
5 No
Additional Comments and/or Drawings:
O5103101

w
Viiisioriliif
iQ� wiii of Water Quality
Soil and' Water Conser-vahon
OWer'Agency r '"
Type of Visit tAlCompliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access I{
Facility Number Date of Visit: Time: I I q,,� G ] Printed on: 7/21/2000
O Not O erational O Below Threshold
Permitted p Certified 13 Conditionally Certified 13Registered Date Last Operated or lbove Threshold: .......................
FarmName: ... ..... m- .......................... _ County: .... .......................................................... -'....................
Owner Name: -------------- ... Phone No:
Facility Contact: .............................................................................. Title:
Phone No:
MailingAddress:-......--.......................................................................................................... .
Onsite Representative: Integrator: •, .^.-
Certified Operator:
Location of Farm:
Operator Certification Number
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �° °- Longitude • 4 46
Design Current Design Current Design Current
Swine Ca acity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 10 Non -Layer I I IFI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagnnn Area JOSprayField Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed. what is the estimated I'low in gal/rain?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes D'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes b'No
Waste Collection & Treatment \\
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes *o
Struc:uare I Structure 2 Structnre - Structure 4 Structure 5 Structure 6
Identifier: ..................................... ..................................... ...................................... ... ................................. .... ............ ........ ............
Freeboard (inches): a."l
5100 Continued on back

Facility Number: - — = Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes P(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [�(No
12. Crop type �� �l✓L� , S►�c.'1 a�4. ��e►-sue l,l•.!_.Y,.,,:„,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.... violatio ........... r► r. notecll dirrtng fhis:vis..... will receive Rio further .
corresp6 idence. about. thIS .visit. • .......... .
Cl Yes b(No
❑ Yes 9No
❑ Yes P No
❑ Yes [9No
❑ Yes 9No
❑ Yes t3rNo
❑ Yes >�No
❑ Yes bdNo
❑ Yes 15-dNo
❑ Yes jrNo
❑ Yes &No
❑ Yes eNo
❑ Yes 0 No
❑ Yes [jNo
❑ Yes ZNo
Comments (refer to question #)c--Eicplain any -YES answers:and/or any -recommendations or any other comments, T
Use—drawingsUse-dfawings of facility to better ex lain.situati_ons. (use additional pages:as necessary):
X_ / Cyr vC p``� i

._... .►
I Facility Number: Date of Inspection c Printed on: 1/9/2001
Odor Issues
25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes RNo
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M/No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )�(No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
5/00

j()(Routine O Complaint O Follow-up f DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection EE= 24 hr. (hh:mm)
Permitted [:].Certified [3 Conditionally Certified 0 Registered 113 Not OperationalOperationall Date Last Operated .
lc
.
Farm Name: ....p.�i`C,� County:......... �."A
... ................ .....
u J ...
Owner Name Phone No: `
•.................................................................................
FacilityContact: ..............................................................................Title:.............................................. Phone No:
MailingAddress:....................................�...................................................................................................................................... ......................... ..........................
Onsite Representative: , „ Integrator:
..........................................................................
Certified Operator: .................................................... ............................. .... .......... ................ .. Operator Certification Number:..................-----------.............
Location of Farm:
Latitude • & 66 Longitude 0 6 «
:°_Dest gn :Current Design Current Design =Current
$wine
Ca actty : Po elation Poultry - Ga `aci ..-Po ulahon r Gattle Ca actty'Po ulaaon .
rW ❑ Wean to Feeder ❑Layer =,' ❑Dairy
Feeder to Finish Q [} Non -Layer ''' ❑Non -Dairy s-
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Msi Ca d
t
❑ Gilts P 3'
❑ Boars Total SSLW
Nuinber of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holden Ponds
" g `I solid Traps =y y ❑ No Liquid Waste Management system _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c" If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ((No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �fNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ...........o`....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes WNo
seepage, etc.)
3/23/99 Continued on Lack

Facility Number: fo= Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ANo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes N�No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes *0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
)*s
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
P<No
11. Is there evidence of over application9 ❑ Excessive Ponding ❑ PAN
❑ Yes
QjNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
4No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
'Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
b(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
%No
Renuired Records & Documents
17., Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes O<NO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ieJ WIIP, checklists, design, maps, etc.) ❑
Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes O(No
20: Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes N(No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes 100
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes U(No
24. Does facility require a follow-up visit by same agency? ❑ Yes MNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ANo
f� yiola�igns:oi deficiencies were hig d. dorjog #his'visit; • Y66 Will tod*e dd futthgr
corresp6fideitce_ ibo' u _ this visit.
q� hem k -fie- 1 d� - � � �ejt4ALA? a&Q_ L-1 fI (h"Cac) A6
�-`� 3 �3�13 � a►- ��� � �*- ��� - r�e�-e �- •�e-v� air
'3L_
IReviewer/Inspector Name
Reviewer/Inspector Signature: Date: —�/ Q

~ Facility Number: — Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes O(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes xNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 1xNo
Ok)Q-VA\ I(_ `� S `^'mil La
�Qp-f LIT `� �,� 506A LIvL-
0
-�-

Division of Soil and:Water'Consetr!atzon -Opera
0 t>on Review '
Division of So oand•Water Conservation ';Com Dance ection ,
p
® Division of Water. Quality , 'Compliance Iitspectton r
-
" _ E3 Other Agency.- Olieratiohr eview
.. .. .
14D Routine Q Complaint Q Fallow -up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection Z y't
Time of Inspection 24 hr. (hh:mm)
® Permitted ® Certified [3 Conditionally Certified 13 Registered JE3 Not O erational Date Last Operated:
Farm Name: ......5A:±`1Di�. � GAMY..-. .[XON.... FAQ.!''1........................
OwnerName:........? a.Q........1�.�i<Q?....................................... . . .............................
Facility Contact: ...................................
.- Title:.....
County:N!-�.!�.....................................t.!L�.
Phone No:.......!.D...324 - 3±d3fci.................... •......
Phone No:
.........................
Mailing Address: ...%t.z�P....... j3.U.g.CZf q..... ......................................... ...... f G1 50/ {V[ LE....,... C................ .... a�.4.C?
Onsite Representative:.... ..... .. .. .... Integrator: Ram-S IniC:
g........ ...... FaDDS
.,0,0)........
Certified Operator: ........-�'�, ,AQY......
Location of Farm:
QRDO.::... Eggtl
-•-,•• Operator Certification Number: �,�?8 -'
...... O .................
-..-............................................................................................................................................................................
Latitude ®• 44 ` �z Longitude 0• 31--1fi59 "
Design Current
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish
a
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area ._
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
❑ Yes qNo
❑ Yes ❑ No
❑ Yes ❑ No
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes []'No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes It Wo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes tg(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes -(No
Structure I Structure 2 Structure 3 Structure 4 Stnicture 5 Structure 6
Identifier:
Freeboard(inches): ........�................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes NtNo
seepage, etc.)
3/23/99 Continued on back

FacilUty Number: Date of Inspection
.'-�6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes �Po`
❑ Yes VrNo
❑ Yes �6o
❑ Yes VNO
❑ Yes )�No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E<No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: N,6-yi61'aiions:or. &ficieocies •were noted -during this:visit; - Yob Will•receive d6 further
• corresporid6c'e: ahoitf this visit : :
❑ Yes Wo
[]Yes )?'NO
❑ Yes IZiVo
❑ Yes Vo
❑ Yes /�No
❑ Yes SZ110
❑ Yes J'No
❑ Yes V No
❑ Yes J�rNo
❑ Yes _VNo
❑ Yes )�`No
� _ �a.. . _ ems. - . ...
ommenis (refer tQ question #) _ Explain any YES answers aii"r any recommendations or.any otiser-commenu`=
Ise°drawings of facility to better explain situations (use addibiinalpages as necessary)
W t
eQ J u r �u� a� E' F� �j �iyf ► %f a a� �'r`e r' y-�Z` aC .�-�e
`� /!1 �c��•c-�-s� �-�— a-r, ,6��-y► iLco� � 5 i �Le. w .��
Reviewer/Inspector Name a
Reviewer/]nspector Signature: cx _ Date: j 9
3/23/99

FacUity Number: Date of Inspection
'' dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes El No
liquid level of lagoon or storage pond with no agitation? \
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JRrNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes P'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes'S�'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes--F�j"No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ' No
3/23/99

k�k-8
Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 61 -q
Farm Name: V d
On -Site Representative:
Inspector/Reviewer's Name: AW_VI�2
Date of site visit: -5—' --4o
Date of most recent WUP:_ V'L— (9
Annual farm PAN deficit: V-1 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part H eligibility item(s) Ft F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption El E2. E3 E4
Operation pended for weft le acre
determination based on P9 P2 P3
Irrigation System(s) - circle #:Qhard-hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system .w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map"depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, 'including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part I1- F1 F2 F3, before completing computational -table in Part Ili).
PART 11.75% Rule. Eligibility Checklist and. Documentation of WA Determination
Requirements. WA Determination .requiredbecause_operationfails -one of the -eligibility
requirements listed below:
_ F9 Lack .ofzcreage_whichTesultedin-overmpplicationmf-wastewater-_(PAN) on:spray_
field(s) :accordingfo#arm'sdast-two years nfirrigation-seconds.
F2 Unclear, -illegible; or lack of information/map.
F3 Obvious feld:limitafions-(numerous_ditches,failurefo=deductTequired:-1-_
buffer/setback acreage;-or25%*:ofiotal_acreageddentified:.inZAWNIR]ncludes
small ;-irregulady-shaped.fields-.fieIds -less -than �5 acres fortravelers-or,lessthan
2 acres for:stationarysprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of
75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
3
r3
1
I
�
�
I
I
FIELD NUMBER'
- hvdrant. Dull. zone. or.Doint numbers may be used in Dlace of field numbers deoendino on CAWMP
and type of irrigation system.- if pulls, etc. cross -more -than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER - must be clearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acreage_exceeding475% of its total:acres and having received less than 50%
of its annual PAN as documented in the farm'sprevious-two years' (1997 & :1998) of irrigation -records, -cannot serve-as,the
sole basisforrequiring a WA Determination:hack-upfields must-be.noted in the -commentzectionarnd mustbe accessible
by irrigation -system.
Part 1V. Pending WA"Determ!nations -
✓ P1 Plan -Jacks -following -information:
P2 Plan -revision maysatisfy�7.5% rule based on adequate overall PAN deficit -and by
adjusting all field acreage -to -below 75% use rate
�_ P3 Other (ie/in process of installing new -irrigation system):

Lagoon Dike Inspection Report
Name of Farm 1 Facility �D'txon (Murphy fi7 - qr)
Location of Farm 1 Facility SR 1105
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:IV
Embankment Sliding?
( Check One, Describe if Yes }
Seepage?
( Check One, Describe if Yes }
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
9127/ 99 _ Names of Inspectors Patrick Grogan
Janet fthh .
< 10 Freeboard, Feet 2.0 - 2.5
1.0 Top Width, Feet 8 - 10
�2 to I Downstream Slope, aH:1v 3 to I
Yes No
Yes No
Yes No
_�VgrY-gOgd - grams.
Yes X_ No
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X_ No
Is Dam Jurisdictional to the Darn Safety Law of 1957?
Other Comments
If Yes, Depth of
{Overtopping, Feet
Yes _ - X No

z,
Lagoon Dike Inspection Report �2)
7gs
19-
Name of Farm/Facility _ `1-- r K PAZ
Location of FarnifFacility � /2!f�=5 _ T_
Owner's Name, Address
and Telephone Number
Date of Inspection 7 Names of Inspectors
Structural Height, Feet T Freeboard, Feet
t
Lagoon Surface Area, Acres Top Width, Feet
Upstream Slope,xH: IV C, 4--)— ------ Downstream Slope, xH:I V I
Embankment Sliding? Yes NO
(Check One, Describe if Yes)
Seepage? Yes No- _
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of ' .A
Vegetative Cover Gj
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes _2�_No
Is Darn Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes w No

. Q Division of Soil and Water Conservation ❑Other Agency
®Division of Water Quality s Tom:
MIT
Routine O Complaint ' O Follow-up of D«'O inspection O Follow-up of DSWC review O Other
Date of Inspection / q
Facility Number 7 *7 Time of Inspection' I:'J 24 hr. (hh:mm)
,Registered Certified © Applied for Permit Ll'l'ermitted 10 Not Opera . Date Last Operated:
Farna Name: 5A!!:a5[....... PrRY.. ptxo� Ff��M County: .... Q1.q.5c.oul......................
...............................................................................
Owner Name- ... 6!4'ZY.... D/� R..................................... ....... Phone No:. �4�.7.::3�-3� 1,F55-�St 7�
L......... ....................-), ..
Facility Contact: 1m..................................................
...,. �r.I....:...#�.lx d'Y�................ Title:........Q..w �` Q 1 ........................... Phone No:
Mailing Address:..... ...... Bv2%i w.. �`� ��...................................................................... ..........................
C,4,2.2oc
Onsite Representative :.....6AQ `(.-...pl............ Integrator:......... G . ......
Certified Operator;..--.-.--. ....'V1.......... Operator Certification Number;.---...-. �. ........
Location of Farm:
�z.o r J c xa�v�u. .....7??wAQQ..&'gq '.7 /..P�eoxi,......-Y......J..../z .rr./,� �- 8�c�'A•
1�a!Q.P.......�!.Y...4M..Q...r...53......YAK. ..................
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes LKNo
2. Is any discharge observed from any part of the operation? ❑ Yes �Vo
Discharge originated at: []Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in valhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 06o
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes fk&o
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes RNo
maintenancetimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7..Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 - ,
Continued on back

Facility Numhcr:(o 7 — I 7
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
1'No
Structures ([,aLoons,11oiding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft):..........A..��......................
W. Is seepage observed from any of the structures'?
❑ Yes:�O
o
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
El Yes
12. Do any of the structures need maintenance/improvement?
❑ Yes
4\No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
K\o `
Waste Application
14. Is there physical evidence of over application?
Cl Yes
Q4�0
(If in excess of W,MP, or runoff entering waters of the State, notify DWQ)
15. Crop type C6'VJt- lJbp".............................. .......................................................................................
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
5jNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
VNo .
18. Does the receiving crop need improvement?
❑ Yes
hNo
19. Is there a lack of available waste application equipment?
❑ Yes
kNo
24. Does facility require a follow-up visit by same agency'?
❑ Yes
&No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative`?
❑ Yes
q\b
22. Does record keeping need improvement?
❑ Yes
EVT0
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ONO
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
❑ Yes
KNo
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
§ZNO
a-No.viol or deficiencies werenote'd-during this.v_ isit. Youmill receive no further.
:-correspotadenceabout-this:visit:•.•��"�: :�:�� .���,�� : � -� �-.-�•.���. �.:-����_-� : �� � . .•��.•
mments_(te_ -_ question #): -Explain: any YES answers and/or any recommendations'. any-o1
e drawings of.l'actlity t;o.lhetfer explain situations. (use additional pages as necessarv),
7/25/97
Reviewer/Inspector Name
P.4T. Du�15iT
A 3'v
.'
Reviewer/Impector Signature:
�-C
Date:
/

® Routine 0 Complaint 0 Follow-up of Dn inspection 0 Follow-up of DSNVC review 0 Other
Date of Inspection Z
Facility Number 'j
Time of Inspection I it: l 5_j 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:115 for 1 hr 15 min)) Spent on Review 3.
® Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ... ............ _ ......
FarmName:.//__ .........�!4........ L...o!� ............... ._ .... County: _ ....� vt5 ... .......
Land Owner Phone No:
Facility Conctact:... � 2 ... .1� �.?�, ....... Title: ....... ....... .. Phone No: `� Z.3 �
Mailing Address: l%z(r�trC?'�!- ..� _._........................
OnsiteRepresentative:... t... . Integrator:
Certified Operator:.... .............. ) .I . d� .. ........ Operator Certification Number:.1.�........ ,.
Location of Farm:
.... pas&... GrG�S tk�6. �. �.�±,!Y✓�Sl.... c�_A!.:..�:...5.3... �r�es�{1::�5�...:..re??z-. A... 14
......ty
Latitude \ • E 0 u Longitude•
Type of Operation and Design Capacity
s Design `Current D sign Current Design Current
Sworetry : Ga ace Po� ulatron w,� Ca act Population.....� P.oul„ Cat#le Ca' aci Po Vuliition
Wean to Feeder L a ^er ❑ Dairy
Feeder to Finish 1-1WO ❑ Non -La er " ❑ Non-DaiTyj
Farrow to Wean r Ea
Natal Design Capacity .0 .
Farrow to Finish I1Total s Wi, lis D
❑ Other _ £;
rx.- .... k`.Y'°�t"': ... x yre..-�- „-waaarrwa.< : -.:.a , - ;??s.xi,•4i+ aw_,.E`;'. „'"v {..,.x�. s' a"ir >: t, :.•°.s'`.`.
Number of Lagoflns ! Holding Ponds I Subsurface Drams Present
u.
❑Lagoon Area ❑Spray Field Area
"I
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed; did it reach Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 0'1�o
❑ Yes
❑ Yes UKo
■ : ,,
❑ Yes
ONo
❑ Yes
M-go
❑ Yes
9-1go
❑ Yes
UNo
Continued
on back

,r .FaCllity Number:.....iR.... —...oaf.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes [9-No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Hglding Pond
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
❑ Yes Pto
❑ Yes M'No
❑ Yes 2'1 To
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 5 r r�
_ ............ ............. ..... ..... .... W.... _.... ..... _ ....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes O-1-
❑ Yes UNo
❑ Yes G�6`
❑ Yes Eddo
❑ Yes 9<0
❑ Yes M-No'
❑ Yes [Wo
❑ Yes Q�No
❑ Yes B No
❑ Yes O-No
❑ Yes M-2do
❑ Yes RNo
El Yes [ io
❑ Yes [moo
Comments {refer to°question #f) Explain any YES �answers`and/or any recommendahons'orany other coti�ments
Use drawings o(facility to better explain situattons'(use addrhonal;=pages,as necessary) A
C f aT ` ' Z b t� 1 A AN C tl L r, u 4 i'r `oA& V AYci Ir, 04 ATL 4'bv,.5
Z S p.,4.k) . nn, R - 3L+� �-� r .tl�4� �i . s r� . F-rx-
f-vo/D OF A PP I I C44 t, oiJ r1 &-r£ s. A c e-1 k&rL e F
}� Arc,cUR-aTL.. ALSO, TA c. 1.iy ,,, Vie, G"-O LcK
Reviewer/InspectorOgg
Reviewer/Inspector Signature:—DM-L Date: 1,67 �-
cc., Division of Water Quattty, Water duality Section, Facility Assessment Unit 4/30197

Site Requires Immediate Attention: A" 0
Facility No. (n 7. 4 7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 - , 1995
Time: y / f
Farm Name/Owner: /XD�ls F%2M G�9rzY /Xoi��
MailingAddress: J� c,�s��vv�li .. NG � �s �a
u�Aw
County: e2/0scaw
Integrator: (,a r,%//r Phone:
On Site Representative: �5a4r.m s Gco—i ,y(1-7, Phone:
Physical Address/Location: A 9,'"y M i le t Pa sr ceossed, a 5o utl tvP cn� N� S3
61119'41N6 SB&rfl MW424 R09CAw h,eaA �lA��sdNcy/Io
Type of Operation: Swine - Poultry Cattle
Design Capacity: _Z/ (P'O Number of Animals on Site: 17 co 0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 rf U q , (S " Longitude: 7 7 " 31' , 5.5 " Elevation: 20 Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: __�`Ft. Inches
• Was any seepage observed'from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray;�6,
Yees No - Is the cover crap adequate? Ye or No
Crop(s) being utilized: C Ak4
Does the facility meet SCS minirnum setback criteria? 2�Oftet from Dwellings? es r No
100 Feet from Wells?(Yee or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oho
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or•`No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? des or IVa
Additional Comments: fh 00 h An —A -
Inspector Name
Signature
cc: Facility Assessment Unit , I Use Attachments if Needed.

UF'ERHTTGNS BRANCH - WQ Fax:919-71�-6048
Jul 24 '95 18:20 P.18/18
Site Requires Immediate Attention A,a
Facility Number: _ G 7- — V-7
• SITE VISITATION RECORD
DATE: X&e is , 1995
JUL
Owner: R4- 0"s Farm Name: D r . a,., y, ,� „p.w_.••
County: 0'vJe.0... SOH
Agent Visiting Site: lyxL-r. _ _ _ phone; * V,7A
Operator: Ci^y oVe-ot Phone: lfl�1_ 3 V-7 - Jeldc On Site Representative: j 4,% w Phonc:
Physical Address: _ ��.cJrk• ( �+r.�. E+Ar% Cib•s� ied- .oT 440 a r" on. tic .rz
/iCA►yF: � 4� i 4+.9q +f, L� I+.+ /L r+^h rOm.�'1...✓r �� —
Mailing Address:
f at l,s'nnIIt,
Type of Operation: Swine Poultry Cattle
Design Capacity: _ /'eyo Number of Animals on Site:
Latitude: d Longitude: 0 '
Type of Inspection: Ground Aerial
• (-ircic Yes car Net
Does the Animal Waste Lagoon have sufficient freeboard. of 1 foot + 25 year 24 hour storm event
(approximately I Foot +$ inches) (9 or No Actual Freeboard: _y Feet ___e_ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard Under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or�2 Was there erosion of the darn?: Yes o(!5)
is adequate land available for land application? es r No Is the cover crop adequate? Vg3br No
Additional Comments: _._=,�f i •+aw ;'� _�°�...,r►�if' i•�1��c,�,Co-+•w - -
Fax to [phone] r Sign tore of A